Healthcare Provider Details

I. General information

NPI: 1134016785
Provider Name (Legal Business Name): BENJAMIN DAVID COLLINS LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 GRAND RIDGE CT NE STE 200
GRAND RAPIDS MI
49525-7043
US

IV. Provider business mailing address

2029 BRIDGEPORT RD NE APT 121
GRAND RAPIDS MI
49505-6308
US

V. Phone/Fax

Practice location:
  • Phone: 616-426-9034
  • Fax: 616-404-4103
Mailing address:
  • Phone: 708-949-1628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: